Kailash Chand on the BMA’s opposition to NHS reforms

Kailash ChandBMA members rather than the organisation itself called a special representative meeting (SRM) on the 15th March 2011, the second in two decades. Dr Hamish Meldrum, the chair of the BMA council, appeared visibly anxious and keen to maintain the unity of the profession. In a professionally delivered speech he struck exactly the right balance between anger (“I do not support this bill. The BMA does not support this bill. The profession does not support this bill”) while remaining in touch with reality (“We need to be realistic about where we are now and what we wish for”).

Initially I was a little disappointed that the BMA pulled back from outright opposition, but now on reflection I feel that we achieved a lot. Pragmatism carried the day. As a critic, in my view we should have avoided the division on motion 175. Most observers will find it a bit odd for the SRM to vote for the Health and Social Care Bill to be withdrawn (motion 35), but not to oppose it outright. Passing the motion for all out BMA opposition to the health bill in my view could have delivered not just a bloody nose but potentially a knockout blow to an already under pressure Andrew Lansley, but it would have given the BMA very little room for manoeuvre.

However, the sentiment of the meeting throughout the day was to oppose clause after clause of the rotten bill. The BMA leaders have stuck their necks out saying they can get the bill modified. That is why they did not actively oppose the motion 175.  Strange logic but I think it had more to do with saving the face of the BMA than thinking about the NHS or patients.  A competitive market is at the heart of Mr Lansley’s whole vision, and regardless of whether one is heartened or horrified by that, trying to tamper it into some sort of hybrid managed market is a recipe for muddle.

Andrew Lansley’s Health and Social Care Bill with its plans to abolish SHAs and PCTs and herd GPs en masse into commissioning consortia represents the most radical reform of the health service since 1948. This reform will impact on all those who deliver and receive NHS services.

For patients it threatens to fragment their care even further and to take the “national” out of the National Health Service. For those delivering care (GPs, consultants, nurses, and all other care professions) it places them at the front line of a reliable institution where we are all prone to amplify the unacceptable – for most this is often our clumsy way of saying that we don’t want our NHS diminished. A significant majority of the BMA believes that the health and social care bill is an attempt at using the market forces of “creative destruction” to fundamentally change how they practice so that quality of care is subjugated by economic austerity.

The question then is where does the British Medical Association now stand after the SRM? The answer has to be that it is on a knife edge between the doctors in hospitals and in GP practices that are at best doubtful about the proposed reforms, and between those who are vehemently against Andrew Lansley’s proposals.

The truth is that the medical profession is exhausted by successive Government NHS reforms – 15 in the last 30 years. These latest reforms will open further the gaps in the pathways of patient care at a time when patient satisfaction with the NHS has never been higher. These “care gaps” are the product of two things: increasingly private sector models of hospital care under the Foundation Trusts and the disassociation of local democratic accountability as the NHS is denationalised. Mr. Lansley’s reforms are a serious threat to healthcare delivery as we know it. Opposition from the
profession is on the increase not least because of the profound effects on their terms & conditions of employment, pensions, medical training and professionalism, but also because they foresee that the knock on effects for patient care will be devastating. Amazingly, the coalition has been getting away with this because there has so far been far too little understanding and resistance from the BMA, which is realistically the only organisation that can prevent this assault on the NHS.

It is really testing time for the BMA’s leadership. The BMA membership needs to hold the BMA leaders to their pledge. I guess the test will be whether there are acceptable amendments to the Bill.

Kailash Chand has been a GP for last 30 years and is now chair of the NHS Trust Tameside &
Glossop. He was on the BMA council and general practitioner’s committee until last year. He was awarded an OBE in 2010 for services to the NHS. He writes for the Guardian, and other regional and national publications on health matters

  • Drsatyasharma

    Kailash has written a well balanced article which would strike a cord with majority of right thinking BMA members.

    It is true that BMA has a very difficult situation.

    If the bill changes in a acceptable to vast majrity of the BMA members it will have better outcomes in terms of implementation and enhanced benefits for patients.

    It is also true to say that profession is tired of making changes but this is one change which will influence NHS beyond recognition.

    Satya Sharma

  • Fight Corruption

    Dr Chand is too kind on the BMA. There has been so much compromise over the years with governments whose relentless reforms have not benefited patients. NHS direct and the 4 hour A+E waiting time target are prime expamles which have wasted millions of pounds of tax payers money. I don't know whether it's comical or disheartening when Lansley speaks of the NHS requiring radical change to sustain itself. It is in fact the constant meddling by politicians that have got us into the current mess in the first place. Unfortunately the vast majority of hospital doctors perceive the BMA as a separate entity, unrepresentative of the views of grass root clinicians. Let's be honest most politicians have NO idea of the complexities of medical practice.The battle now is how we sustain what was once the envy of the world: The long held principle that makes me proud the be part of a NATIONAL health service: that we provide care to patients on their clinical need NOT their ability to pay. It is this principle which also gives doctors in this country some moral authortity unlike the United States where medical care is a business. No one should be fooled here. All these reforms will lead to the Privatisation of health care and the end of the NHS as we know it. We can and should prevent it if there is more solidarity amongst doctors and we act with a spine, something which is lacking in the BMA leadership. We have a very powerful trump card which should not be forgotten. THE PUBLIC TRUST DOCTORS NOT POLITICIANS, PATIENTS TRUST DOCTORS NOT POLITICIANS!!

  • Abdul Jaleel

    I too attended the SRM last week and [as a Life Member } felt disappointed that the BMA has lost its way on this issue : They could not oppose it outright as that would send out a negative signal to the general public [“BMA is a doctors union and opposes everything “] nor could it embrace the Bill without suffering the unjustifed taunts from the members {principally the GPs } who have the potential to gain most from the Bill.

    No wonder, poor Hamish Meldrum looked tense but masterfully concealed
    his most difficult conference sincetaking the Council Chair.
    What a waste of BMA resources just to placate a few hot-heads and silence its conservative members [notice the small c ].
    I like Kailash's presentation skills in blowing hot and cold when it comes to NHS politics.

  • Abdul Jaleel

    Regret an Omission in my earler contribution today : What I meant to say in pragraph 2 about Dr.Hamish Meldrum was that he “masterfully concealed his discomfiture whilst chairing this meeting ” but some of us could gauge it from the non-vebal signs.

  • nhs worshipper

    SRM allowed very many BMA members opportunity to be heard,many were very precise in putting their case . Chair of BMA played his cards right,had right words to express the opposition to the health care bill.Where do you go from here?. How can BMA influence the amendments ?
    Health care bill has nearly divided Primary and Secondary sector professionals,commissioning may not be a power for GPS .Financial pressure
    without demand management will override , the BEVANs principle free and when needed . . Conflict of interest as a provider and purchaser of care may disadvantage old,less articulate,deprived and depressed. Medicine to be delivered at the point of need eqitably to all is not possible with the health bill changes.
    Super markets like SAINSBURYS can have Store doctors ,precisely providing care as a COST AND VOLUME ,and take out the concept of CONTINUITY of care out of medicine.
    We are moving to a care provision depending on the size of your wallet probably than you as a valuable individual. BMA has to show leadership in avoiding Tsunami for our NHS.

  • David Wrigley GP

    This Health Bill really will destroy the NHS as an equitable healthcare system and open up English healthcare to competition between private providers. Your illness will be about how much profit a company can make from it, how much return they can provide to their shareholders and whether the disease you have has a wide enough profit margin.

    We will see a USA style healthcare system – where 50 million USA citizens have no health insurance and receive second rate care compared to those lucky enough to have insurance.

    It is inadvisable to become ill or old under the new coalition health reforms – you may well find the private health companies won't find you profitable enough!

    These reforms are damaging, dangerous, unpopular, undemocratic and definitely bad for your health.

    David Wrigley
    GP in Lancashire and passionately opposed to the Health Bill
    BMA UK Council